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Comparative Study
. 2009 Apr;33(2):477-82.
doi: 10.1007/s00264-008-0542-y. Epub 2008 Apr 12.

Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine

Yu Chen  1 , Deyu Chen, Xinwei Wang, Xuhai Lu, Yongfei Guo, Zhimin He, Haijun Tian
Affiliations
Comparative Study

Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine

Yu Chen et al. Int Orthop. 2009 Apr.

Abstract
in English, French

Between May 2002 and October 2006, 19 patients (17 men and 2 women; average age 57.2; range 47-71 years) received anterior corpectomy and fusion for severe ossification of the posterior longitudinal ligament (OPLL) in our department. Preoperative radiological evaluation showed the narrowing by the OPLL exceeded 50% in all cases, and OPLL extended from one to three vertebrae. We followed-up all patients for 12-36 months (mean 18 months). The Japanese Orthopaedic Association (JOA) score before surgery was 9.3 +/- 1.8 (range 5-12) which significantly increased to 14.2 +/- 1.3 (range 11-16) points at the last follow-up (P < 0.01). The improvement rate (IR) of neurological function ranged from 22.2-87.5%, with a mean of 63.2% +/- 15.2%. The operation also provided a significant increase in the cervical lordosis and the cord flatting rate (P < 0.01). No severe neurological complication developed. We therefore concluded that anterior decompression and fusion was effective and safe in the treatment of the selected patients, although OPLL exceeded 50% diameter of the spinal canal.

Entre mai 2002 et octobre 2006, 19 patients (17 hommes et 2 femmes) âgés en moyenne de 57,2 ans (47 à 71 ans) ont bénéficié d’une corporectomie antérieure avec arthrodèse pour une ossification sévère postérieure du ligament (OPLL). L’évaluation radiologique préopératoire a montré que l’importance de l’ossification était supérieure à 50% dans tous les cas et cette ossification (OPLL) s’étendait sur 1 à 3 niveaux vertébraux. Tous les patients ont été suivis en moyenne de 12 à 36 mois (18 mois en moyenne). Le score de la JOA a été de 1,8 en préopératoire (5 à 12) et a progressé jusqu’à 9,3 à 14,2 (11 à 16) au dernier suivi (P < 0,01). Le pourcentage d’amélioration neurologique a été de 22,2% à 87,5% avec une moyenne de 63,2%. L’intervention entraîne également une amélioration significative de la lordose cervicale et du taux d’applatissement de la moelle (P < 0,01). Aucune complication neurologique sévère n’a été observée. Nous pouvons conclure que la décompression antérieure associée à une greffe est une technique efficace et sûre du traitement des OPLL chez les patients sélectionnés dont le diamètre du canal rachidien doit être supérieur à 50%.

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Figures

Fig. 1
Fig. 1
Case 1. a CT reconstruction images. Preoperative CT image (left) shows a massive local type OPLL at C4-5, and postoperative CT image (right) shows complete resection of OPLL. b MR images. Preoperative MR image (left) shows severe compression of the spinal cord, and postoperative MR image (right) shows satisfying decompression of the spinal cord
Fig. 2
Fig. 2
Case 2. a CT reconstruction images. Preoperative CT image (left) shows a massive segmental type OPLL at C4-5, and postoperative CT image (right) shows resection of OPLL. b Axial CT scans. Preoperative CT scan (left) shows a typical double-layer sign, and postoperative CT scan (right) shows residual of dural ossification (DO) and anterior shifting. c MR images. Preoperative MR image (left) shows insufficient decompression of the spinal cord after unsuccessful laminoplasty, and postoperative MR image (right) shows sufficient decompression of the spinal cord
See this image and copyright information in PMC

References

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